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4 questions to ask before next overhaul deadline

Updated at: 01/13/2014 3:57 PM
TOM MURPHY

More than 2 million Americans met the health care overhaul's deadline last month to sign up for insurance coverage that started Jan. 1. But the enrollment window hasn't slammed shut on the millions more who still need protection in the new year.

The uninsured have until Jan. 15 to find coverage that starts next month, and they have until the end of March to find coverage for 2014 and avoid paying a penalty imposed by the federal law. Here are answers to four questions to help guide shoppers as they hunt for the right plan.

1. How do I determine if I qualify for a subsidy to helps pay my insurance bill?

The health care overhaul provides income-based subsidies to help customers pay their premiums. Insurance shoppers can only qualify for a subsidy if they don't have an affordable option available from their employer. These subsidies apply to individuals or families making up to four times the federal poverty level, so the help stretches well into the middle class.

The Kaiser Family Foundation, a nonprofit organization that studies health care issues, offers a calculator to provide a rough idea of your potential subsidy. It's available at http://kff.org/interactive/subsidy-calculator/ .

The subsidy is based on the applicant's modified adjusted gross income, which is adjusted gross income plus any tax-exempt Social Security, interest or foreign income. Applicants need to estimate what that figure will be for this year to determine the amount of the subsidy.

It's important to be careful with the income estimate. Think about whether you will receive a cost-of-living increase to your salary this year or a bonus or raise.

If your estimate is low and you wind up receiving a higher subsidy than you qualify for, you may have to pay that back when you file your 2014 income taxes. Of course, if your income estimate is too high, you could get a credit.

2. Is March 31 my last chance to gain coverage in 2014?

March 31 may a lasting deadline unless you have what's referred to as a life-changing event that alters your insurance needs. That can include getting married or divorced, having a child or losing a job.

The law set up these specific windows in which customers can enroll to prevent the uninsured from just waiting until they become sick to sign up for coverage. Insurers need healthy customers who don't use the health care system much to counterbalance the sick ones who submit more in claims than they contribute in premiums.

The March 31 deadline also applies to insurance shoppers who buy coverage on the individual market without help form a subsidy.

Those who don't land coverage by this deadline could be hit with a fine that totals $95 per adult or 1 percent of family income, whichever is greater. The law carves out exceptions for Indian tribe members and those who belong to health care sharing ministries, among other groups.

3. The last enrollment deadlines were pushed back, will March 31 be eased as well?

Insurance shoppers who wanted coverage that started Jan. 1 originally had to sign up by Dec. 15. Then that was changed to Dec. 23 and ultimately bumped back to Dec. 24 to accommodate a swell of last-minute enrollees.

Don't count on the same flexibility this time around.

The December deadlines were pushed back in part because many customers had trouble initially signing up for coverage through HealthCare.gov, the main conduit for enrollment in most states. The site's debut was marred by crashes and other technology glitches. Those issues have been largely straightened out.

"I think unless there is some kind of major issue that develops between now and March 15, I wouldn't think that deadline will be extended," said Jennifer Tolbert, a health care overhaul expert with Kaiser.

4. Will customers have an easier time than they did last fall signing up for coverage?

They should because HealthCare.gov is running better. It was down an estimated 60 percent of the time in October, its debut month.

On Dec. 23, the website was able to support 83,000 simultaneous users, according to a blog post by Julie Bataille, communications director for the federal health care rollout.

Government officials have said the site's pages are loading much quicker, and the site's operators were able to employee a queuing system during high-traffic periods that enables visitors to either wait or give an email address to be invited back later.